Provider First Line Business Practice Location Address:
1165 E 54TH ST
Provider Second Line Business Practice Location Address:
APT 3-0
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-312-5846
Provider Business Practice Location Address Fax Number:
347-312-5846
Provider Enumeration Date:
07/22/2009